Compared with women who felt their workplace pressure was suitable, those who reported that the pressure was much too high had a nearly 50% increased risk of developing ischemic heart disease (HR 1.47, 95% CI 1.14 to 1.88), according to Karen Allesøe, PhD, and colleagues from Glostrup University Hospital.

Additionally, those who felt their job pressure was a little too high had a 25% increased risk (HR 1.25, 95% CI 1.04 to 1.50), the researchers reported in the May issue of Occupational and Environmental Medicine.

Previous studies have linked job stress and excessive demands with ischemic heart disease, but the analyses have been largely confined to men. Data on women thus far have been inconclusive.

So Allesøe and colleagues analyzed data from the Danish Nurse Cohort Study, initiated in 1993, when all nurses in the country were sent a comprehensive questionnaire about health and lifestyle.

The analysis included 12,116 women who at baseline were actively employed. Their mean age was 51 years.

During 15 years of follow-up, 580 incident cases of ischemic heart disease occurred.

A total of 369 were angina pectoris, while 138 were myocardial infarction, and 73 were other ischemic types.

About 60% of participants reported that their work pressure was too high, the researchers noted.

The association of heart disease risk and job pressure that was much too high remained significant, although less so, after adjustment for traditional cardiovascular risk factors (HR 1.35, 95% CI 1.03 to 1.76).

Further adjustment for covariates of performing shift work and physical activity at work had only slight influence on the model (HR 1.38, 95% CI 1.04 to 1.81).

When the study subjects were stratified by age, the association of work pressure that was much too high and ischemic heart disease was significant only among those who were younger than 51 at baseline (HR 1.94, 95% CI 1.25 to 3.01).

The apparently greater impact of work pressure on younger nurses may be explained by the retirement of older nurses (retirement age in Denmark is 65) or other factors that become more important with age, the researchers wrote.

In a subanalysis that excluded angina pectoris and only included the more serious, objective disease categories, a significant association with high job pressure remained (HR 1.70, 95% CI 1.10 to 2.62), even when controlling for cardiovascular risk factors and other variables.

No association was seen between heart disease and job control, which was addressed by the question, "How great is your influence on the organization of your daily work?"

The lack of association between heart disease and low job control, the investigators suggested, may relate to the narrowness of the question.

"Furthermore, the question only relates to one of the two dimensions of job control, that is decision authority. We have no information concerning the other dimension, which is skill discretion," they wrote.

Strengths of the study include the size of the cohort, which provided sufficient statistical power; high response rates among the nurses; and information on ischemic heart disease retrieved from a nationwide hospital register.

Also, confounding by gender, education, and socioeconomic status was avoided because of the homogeneity of the study population.

However, residual confounding from unmeasured factors could have occurred, and other important aspects of psychosocial working conditions may have been overlooked, particularly in the control dimension.

"It is important further to investigate factors that contribute to the perception that work pressure is too high, as it may include different aspects of work demands as well as aspects of not being able to control the work load," the authors wrote.

The results of this study should be considered in the primary prevention of heart disease among women, they concluded.

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